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Nasal Dermal Sinus (with Incidental Associated Nasal Fracture)

  • Nasal dermal sinus is a rare congenital anomaly consisting of an epithelial cell-lined tube, the external orifice of which is usually seen as a small punctum along the midline/off midline bridge of the nose.
  • The sinus tract extends superiorly and may or may not communicate with the intracranial space.
  • It results due to a lack of closure of the anterior neuropore during embriogenesis, resulting in an incomplete regression of the dura, with formation of a diverticulum.
  • Clinical Presentation: A small punctum is often seen along the bridge of the nose. Sparse hair can be associated with this punctum. Occasionally, on pressure, cheesy material or clear liquid (CSF) can be expressed from this punctum. Patients may also present with recurrent meningitis.
  • Key Diagnostic Features:
    • Both CT and MRI play complementary roles.
    • CT helps demonstrate the bony defect—enlarged/bifid crista galli and associated defect in the cribriform plate.
    • MRI, due to its inherent soft-tissue resolution, can demonstrate the dermal sinus tract with CSF extending from the skull base to the bridge of the nose, and can rule out an associated epidermoid or dermoid.
    • Intracranial extent, mandatory to assess, is best evaluated by the surgeon at the time of the surgery.
  • DDx:
    • Nasal cephalocele
    • Nasal glioma
    • Epidermoid
    • Dermoid
  • Rx: Surgery
October 2, 2014
A 6-year-old boy presents to the ER with a painful focal nasal swelling 4 weeks after minor trauma to the face. A clear liquid discharge was noted at this site. The glucose rapid test for the liquid discharge was positive, suggestive of cerebrospinal fluid. There was no history of prior surgery or any prior nasal swelling.
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